title: A rare case of secondary syphilis manifesting as immune reconstitution syndrome in an HIV-positive patient.
abstract: A 44-year-old HIV-infected male, having a low CD4 count, was on antiretroviral therapy for the last 2 months, when he developed a skin rash. He gave a history of solitary unprotected extramarital sexual contact 6 months before onset of the rash. Dermatological examination revealed a bilaterally symmetrical, maculopapular erythematous rash involving the palms, forearms, and neck. He showed a positive sign of Buschke-Ollendorff. In the meanwhile, the CD4 count had improved to 196 cells/mm(3) from the previous count of 92 cells/mm(3) and the viral load had decreased. Serum venereal disease research laboratory (VDRL) test was reactor at 1:64. He was found to be positive result for treponema pallidum hemagglutination test. Skin biopsy revealed features of secondary syphilis. The rash responded well to a single injection of benzathine penicillin, resulting in the lowering of the VDRL titers. There was no evidence of neurosyphilis. This is a very rare instance of secondary syphilis manifesting as immune reconstitution syndrome in an HIV-positive patient.
authors.affiliation: Department of Dermatology, Command Hospital, Wanowrie, Pune, India.
authors.forename: Biju
authors.initials: B
authors.lastname: Vasudevan
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: Vijendran
authors.initials: V
authors.lastname: Pragasam
authors.forename: Ambresh
authors.initials: A
authors.lastname: Badad
authors.forename: Debdeep
authors.initials: D
authors.lastname: Mitra
authors.forename: Vikram
authors.initials: V
authors.lastname: Singh
mesh_terms: D000328:Adult; D015658:HIV Infections / Q000276:immunology* / Q000382:microbiology*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology / Q000382:microbiology* / Q000821:virology; D008297:Male; D013587:Syphilis / Q000276:immunology* / Q000821:virology*
keywords: HIV; benzathine penicillin; immune reconstitution inflammatory syndrome; syphilis